| NPI | 1740270065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: AZ 49215) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 015171) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D008817) | |
| 208600000X Surgery (Licence: MO 37000) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2018-05-15 |